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Young People at the Centre of HIV/AIDS Epidemic
The island nation of Maldives has 34% of its total population of 328 000 in the age group of 10-24
years1. At the end of 2003, the estimated number of adults and children living with HIV/AIDS was less
than 200. All the 142 reported cases from 1991 to 2004 were in the age group of 20-45 years. The estimated HIV prevalence among the 15-49 year age group was 0.1% in 20012 (Table 1).
years1. At the end of 2003, the estimated number of adults and children living with HIV/AIDS was less
than 200. All the 142 reported cases from 1991 to 2004 were in the age group of 20-45 years. The estimated HIV prevalence among the 15-49 year age group was 0.1% in 20012 (Table 1).
Young People Are Vulnerable to HIV & STIs
The major route for HIV transmission in Maldives is heterosexual. Though the presence of HIV/AIDS is scant in Maldives, increasing numbers of sexually transmitted infections (STIs) are being reported. An STI survey conducted among antenatal clinic attendees during 2002 found high prevalence of Candida (11.5%), Gonorrhoea (4.1%), HSV2 (3.4%) and Chlamydia (2.9%) 3. Increasing numbers of reported cases of STIs and high prevalence of STI indicates the presence of risky sexual behaviourpatterns. Similar high-risk behaviours are also responsible for spreading HIV. The probability of contracting HIV infection also gets significantly enhanced in the presence of STIs.
The findings of the Reproductive Health Survey 2004 revealed that most young people had correct knowledge about STIs, their transmission and prevention4. Very few unmarried young people (3%) were unable to mention any prevention method and only 4% did not know how to protect themselves from STIs. About 67% of the surveyed unmarried young population thought that the best way to avoid STIs was to avoid sex with people with STIs. Fifty-
one percent males and 44% females reported the best way of STI prevention was consistent condom use (Table 2).
However, 65% of the youth still felt that they needed more information about how to prevent STIs, which implies that young people need more information and skills to protect against the same.
Though aware of prevention and transmission of STIs, young people scored low on knowledge of symptoms of STIs. A quarter (26%) of the youth surveyed did not know of any signs or symptoms of STIs. The most frequently mentioned symptoms were urination problems (51%), being itchy and sore (50%) and discharge (45%) (Table 3).
Why Young People Are More Vulnerable
Early initiation of sexual activity
Results of the Reproductive Health Survey 2004 of Maldives revealed that sexual activity begins early among young people. More than 62% of the sexually active youth reported having their first sexual experience before the age of 18 years. The duration of premarital sex has also increased with increasing average age of marriage4. Almost half of the youth (49%) participating in the survey reported having a girlfriend/boyfriend. Of them 63% met their partners regularly, 4% had sex with others of their own age group while another 4% reported having sex with older people. Research suggests that an early debut of sexual activity among young people often exposes them to multiple partners, including those who have been at risk of HIV exposure, accentuating their HIV vulnerability.
Young people are also exposed to unwanted sexual activity. Four percent of young men and women experienced unwanted sexual activity with someone of their age. Four percent of youth also reported having been sexually exploited by someone older than themselves4.
Young people lack information and skills
Data available on the awareness indicators in the country show that 99% of youth have heard about HIV/AIDS1. Ninety one percent know of at least two ways of transmission and prevention. High levels of awareness can be attributed to the high levels of literacy in the country.The data from the Reproductive Health Survey indicate that 10% of youth did not know that HIV could be avoided. Almost half the respondents felt that the best way of prevention was using condoms (Table 4).
However, when perceptions about HIV/AIDS and related issues were explored, about one-third (34%) of youth did not know that healthy looking people could be HIV-positive. About 24% did not know if HIV could be transmitted by sharing meals with HIV/AIDS infected person (Table 5).
Risky sexual behaviour of a large proportion of young people also indicates that there is a major gap between young people’s knowledge and behaviour. The Reproductive Health Survey 2004 found that most of the young people were indulging in unprotected sex. Of the surveyed youth who were sexually active, four per cent did not know what a condom was and 45% had never used one. There were also some legal barriers to buying condoms since it required a prescription5.The risk perception of contracting HIV was also low among the youth. In general, HIV was associated with foreigners, Maldivians working abroad and those who are employed in resorts.
Restrictive social norms inhibit young people from discussing sex and related issues with others. Young people are also not comfortable in discussing matters related to sexual health with their parents. Nearly a quarter (24%) of the youth of the country believed that talking about condoms makes a person more promiscuous while 48% were confused about whether they should discuss the issue at all4.
The most common sources of information about sex reported by youth were school (48%), television and radio (41%) and friends (41%). Though health facilities were indicated as the place from where young people would like to seek information on sex, many expressed the need to get the information in a more confidential setting. Young people’s concerns about privacy and confidentiality at health facilities often act as barriers depriving them of essential information and skills.
Focusing on the Young to Halt the Spread of HIV/AIDS
The vision of the country’s HIV/AIDS and STI programme is to limit transmission of HIV/AIDS and minimize the personal and social impact of HIV infection. The National Policy on HIV/AIDS of the government of Maldives provides clear guidelines to ensure that no person would be discriminated against on the basis of his/her HIV status. The guidelines stipulate that all testing as far as possible, will be voluntary with prior informed consent and all efforts made to ensure the confidentiality of HIV-positive cases.
Information on HIV/AIDS and STI will be made available to all citizens according to their developmental age. HIV/AIDS and STI diagnosis and treatment facilities will be available at all levels. While stressing the importance of Islamic values in the prevention of HIV and STIs, information on various methods of prevention such as condom use and safe sex will be encouraged.
Key strategies and initiatives of the government include :
• Information, Education, Communication (IEC).
• Prevention of HIV transmission
• Treatment, care and counselling
• Access to care and participation of community and other organizations.
• Sentinel surveillance.
Current programmes on HIV/AIDS targeting young people
In order to create awareness among youth on HIV prevention and control of high-risk behaviours, disseminating information through trained peer educators is considered to be one of the most effective methods in informing the community and high-risk groups.
Maldives has established the voluntary counselling and testing services in Male and two more atolls (Gn atoll and Seenu atoll) with the aim of providing comprehensive care and management of HIV infection throughout the country.
References:
- Young people and HIV/AIDS: opportunity in crisis. Geneva: WHO / UNICEF / UNAIDS, 2002. Health-related Millennium Development Goals : update after the high-level plenary meeting of the United Nations General Assembly
- (September 2005) : report by the Secretariat . EB 117. Geneva: World Health Organization, 2006. Epidemiological fact sheets on HIV/AIDS and sexually transmitted infections - Maldives, 2004 updated. Geneva: UNAIDS, UNICEF
- and WHO, 2004. Republic of Maldives Reproductive Health Survey 2004. Male: Ministry of Health, Maldives, UNFPA/Maldives and CIET, 2004.
- (Accessed 31 Aug 2006: http://www.ciet.org/en/documents/projects_library_docs/ 2006224101944.pdf#search=%22reproductive%20health%20survey%202004%20%2B%20maldives%22).
- World Health Organization, Regional Office for South–East Asia. Family Planning Saves Lives - an investment in development: fact sheet. New Delhi, 2004. (Accessed 11 October 2006: http://w3.whosea.org/EN/Section13/Section36/Section1726.htm).
via World Health Organisation (WHO)
Posted in: Health / HIV
